RESUMO
Antecedentes: La malformación arteriovenosa (MAV) en cabeza y cuello sintomática en el adulto es un enfermedad infrecuentey potencialmente fatal.Objetivo: Describir el manejo quirúrgico y resultado de dos casos de pacientes tratados por MAV avanzada del adulto en la mejilla.Lugar de aplicación: Hospital universitario de tercer nivel.Diseño: Retrospectivo observacional.Población: Dos pacientes adultos varones con MAV sintomática en la mejilla.Método: Revisión de historias clínicas e informes patológicos.Resultados: Ambos pacientes se presentaron con grandes masas y habían sido tratados previamente con embolizaciones sin éxito.Ambos eran estadio Schobinger III. Se realizó una resección amplia y reconstrucción con colgajos libres: anterolateral de muslo en un caso, y de peroné y anterolateral de muslo en el otro. Evolucionaron sin complicaciones con aceptable resultado estético. Se encuentran libres de enfermedad a 50 y 30 meses de seguimiento.Conclusiones: El tratamiento quirúrgico requiere un equipo multidisciplinario con experiencia para una extensa resección, agresiva reposición de sangre y fluidos, y una reconstrucción compleja con colgajos libres.
Background: Sympthomatic adult arteriovenous malformation (AVM) in the head and neck is an unfrequent and potential lifethreatening disorder.Objetive: To describe surgical management and outcome of two cases of surgically treated advanced cheek AVM.Setting: Third level universitary hospital.Design: Retrospective observational.Population: Two adult male patients with symptomatic AVM of the cheek.Method: Review of clinical records and pathological reports.Results: Both patients presented with great masses and had been previously treated with unsuccessful embolizations. They wereSchobinger III stage. It was undertaken wide surgical resection and reconstruction with free flaps: antero lateral thigh flap in onecase and fibular and anterolateral thigh flap in the other. Evolution was uneventful with acceptable cosmetic result. They are lesionfree at 50 and 30 months of follow-up.Conclusions: Surgical treatment requires an experience and multidisciplinary team for extensive resection, aggressive blood andfluid reposition, and complex reconstruction with free flaps.
Assuntos
Humanos , Malformações Arteriovenosas , Cabeça , Pescoço , Bochecha , Cirurgia Geral , TerapêuticaRESUMO
Antecedentes: La malformación arteriovenosa (MAV) en cabeza y cuello sintomática en el adulto es un enfermedad infrecuente y potencialmente fatal. Objetivo: Describir el manejo quirúrgico y resultado de dos casos de pacientes tratados por MAV avanzada del adulto en la mejilla. Lugar de aplicación: Hospital universitario de tercer nivel. Diseño: Retrospectivo observacional. Población: Dos pacientes adultos varones con MAV sintomática en la mejilla. Método: Revisión de historias clínicas e informes patológicos. Resultados: Ambos pacientes se presentaron con grandes masas y habían sido tratados previamente con embolizaciones sin éxito. Ambos eran estadio Schobinger III. Se realizó una resección amplia y reconstrucción con colgajos libres: anterolateral de muslo en un caso, y de peroné y anterolateral de muslo en el otro. Evolucionaron sin complicaciones con aceptable resultado estético. Se encuentran libres de enfermedad a 50 y 30 meses de seguimiento. Conclusiones: El tratamiento quirúrgico requiere un equipo multidisciplinario con experiencia para una extensa resección, agresiva reposición de sangre y fluidos, y una reconstrucción compleja con colgajos libres.(AU)
Background: Sympthomatic adult arteriovenous malformation (AVM) in the head and neck is an unfrequent and potential life threatening disorder. Objetive: To describe surgical management and outcome of two cases of surgically treated advanced cheek AVM. Setting: Third level universitary hospital. Design: Retrospective observational. Population: Two adult male patients with symptomatic AVM of the cheek. Method: Review of clinical records and pathological reports. Results: Both patients presented with great masses and had been previously treated with unsuccessful embolizations. They were Schobinger III stage. It was undertaken wide surgical resection and reconstruction with free flaps: antero lateral thigh flap in one case and fibular and anterolateral thigh flap in the other. Evolution was uneventful with acceptable cosmetic result. They are lesion free at 50 and 30 months of follow-up. Conclusions: Surgical treatment requires an experience and multidisciplinary team for extensive resection, aggressive blood and fluid reposition, and complex reconstruction with free flaps.(AU)
RESUMO
Lymph node mapping and sentinel lymph node biopsy are currently used to stage patients with cutaneous malignant melanoma. Immunohistochemical stains contribute to the detection of micrometastases; however, molecular biology techniques are associated with better diagnostic sensitivity. Sixty sentinel lymph nodes were included in this study. The primary lesions were malignant melanoma stage I or II, with a follow-up of longer than 2 years. Sentinel lymph nodes were studied with hematoxylin-eosin, immunohistochemistry for S-100 and HMB-45, and molecular biology techniques (reverse transcription (RT)-PCR) for the detection of tyrosinase messenger RNA. In 15 of 60 cases (25%), tyrosinase was detected by RT-PCR; three of these cases were also positive by immunohistochemistry. The population was divided into three groups: (i) hematoxylin-eosin-/immunohistochemistry+/molecular biology techniques+ (3 cases); (ii) hematoxylin-eosin-/immunohistochemistry-/molecular biology techniques+ (12 cases); (iii) hematoxylin-eosin-/immunohistochemistry-/molecular biology techniques- (45 cases). Correlation of the groups with overall survival showed the following: (i) 2 of 3 patients died (67%); (ii) 5 of 12 died (42%), and (iii) all 45 patients are alive, with no lymphadenectomy and a median follow-up of 84 months. The inclusion of molecular biology techniques appears to be of great value for the detection of sentinel lymph node micrometastases in patients with cutaneous malignant melanoma. In our series, those patients who showed negativity with all the three methods had a null recurrence rate. Therefore, this triple negativity could be a positive prognostic factor for overall survival. Our findings suggest the possibility of molecular oncological staging, which would allow the selection of patients with submicroscopic metastases for a complete treatment.